Recommended
More Related Content
What's hot
What's hot (20)
Similar to Liver tomour
Similar to Liver tomour (20)
More from syed ubaid
Recently uploaded
Recently uploaded (20)
Liver tomour
- 2. DR.SYED UBAID M.S(KEM MUMBAI) FMAS LAPAROSCOPIC AND GENERAL SURGEON ASSOCIATE PROFESSOR OF SURGERY IIMSR,JALNA
- 3. WORKUP ALGORYHM FOR LIVER MASS Mass on scan History of prior malignancy No history of prior malignancy
- 4. History • Symptoms - abdominal pain/ pressure effect,fever,anoraxia,weight loss • Patient characteristics (age, gender, use of OCP, risk factors for chronic liver disease ) • History or findings of extrahepatic malignancy
- 5. Physical examination and investigation • Sign of chronic liver stigmata or portal hypertention • Lymphadenopathy • CBC with PLT , coagulogram , LFT , hepatitis profile , tumor marker • Ultrasound , CT scan , MRI
- 6. Find needle biopsy • commonly used to assist in the diagnosis of a variety of liver lesions • Disadventage – Increase risk of bleeding and seeding of neoplastic cells – Some type liver lesion cannot diagnosis such as hepatic adenomas and focal nodular hyperplasia
- 7. Multiphasic CT For detection of liver lesions • Non enhance CT • Arterial phase • Portal venous phase • Delayed
- 8. Understanding the phases • Liver has dual blood supply • Normal parenchyma is supplied for 80% by the portal vein and only for 20% by the hepatic artery • All liver tumors get 100% of their blood supply from the hepatic artery
- 9. Arterial phase • In the arterial phase hypervascular tumors will enhance via the hepatic artery, when normal liver parenchyma does not yet enhances, because contrast is not yet in the portal venous system. • Hypervascular tumors will enhance optimally at 35 sec after contrast injection
- 10. Portal venous phase • To detect hypovascular tumors • Scanning is at about 75 seconds
- 12. LIVER TOMOUR
- 13. Delayed Phase • Begins at about 3-4 minutes after contrast injection and imaging is best done at 10 minutes • Valuable for washout of contrast(HCC),retention of contrast(heamangioma),retention of contrast in fibrous tissue (capsule of HCC, central scar of FNH)
- 14. Classification • Hemangioma • Focal nodular hyperplasia • Adenoma • Liver cysts 1. Primary liver cancers • Hepatocellular carcinoma • Fibrolamellar carcinoma • Hepatoblastoma 2. Metastases Benign Malignant
- 15. Benign Liver Lesions 1. Hemangioma 2. Focal nodular hyperplasia 3. Adenoma 4. Cysts
- 16. Hemangioma Clinical Features • The commonest liver tumor • 5% of autopsies • Usually single small • Well demarcated capsule • Usually asymptomatic
- 17. Hemangioma Diagnosis and Management Diagnosis • US: echogenic spot, well demarcated • CT: venous enhancement from periphery to center • MRI: high intensity area • No need for FNA Treatment • No need for treatment
- 18. Peripheral nodular enhancement follow by gradual centripetal enhancement
- 19. CT/Hemangioma
- 20. Focal Nodular Hyperplasia (FNH) Clinical Features • Benign nodule formation of normal liver tissue • Central stellate scar • More common in young and middle age women • No relation with sex hormones • Usually asymptomatic • May cause minimal pain
- 21. Focal Nodular Hyperplasia (FNH) Diagnosis and Management Diagnosis: • US: Nodule with varying echogenicity • CT: Hypervascular mass with central scar • MRI: iso or hypo intense • FNA: Normal hepatocytes and Kupffer cells with central core. Treatment: • No treatment necessary • Pregnancy and hormones OK
- 23. CT/FNH
- 24. Hepatic Adenoma Clinical features • Benign neoplasm composed of normal hepatocytes no portal tract, central veins, or bile ducts • More common in women • Associated with contraceptive hormones • Usually asymptomatic but may have RUQ pain • May presents with rupture, hemorrhage, or malignant transformation (very rare)
- 25. Hepatic Adenoma Diagnosis and Management DX • US: filling defect • CT: Diffuse arterial enhancement • MRI: hypo or hyper intense lesion • FNA : may be needed Tx • Stop hormones • Observe every 6m for 2 y • If no regression then surgical excision
- 26. HA
- 27. Adenoma
- 28. Liver Cysts • May be single or multiple • May be part of polycystic kidney disease • Patients often asymptomatic • No specific management required • Hydated cyst
- 30. Malignant Liver Tumors 1. Hepatocellular carcinoma (HCC) 2. Fibro-lamellar carcinoma of the liver 3. Hepatoblastoma 4. Intrahepatic cholangiocarcinoma 5. Others
- 31. HCC: Incidence • The most common primary liver cancer • The most common tumor in Saudi men • Increasing in US and all the world
- 32. HCC: Risk Factors The most important risk factor is cirrhosis from any cause: 1. Hepatitis B (integrates in DNA) 2. Hepatitis C 3. Alcohol 4. Aflatoxin 5. Other
- 33. HCC: Clinical Features • Wt loss and RUQ pain (most common) • Asymptomatic • Worsening of pre-existing chronic liver dis • Acute liver failure O/E: • Signs of cirrhosis • Hard enlarged RUQ mass • Liver bruit (rare)
- 34. HCC: Metastases • Rest of the liver • Portal vein • Lymph nodes • Lung • Bone • Brain
- 35. HCC: Systemic Features • Hypercalcemia • Hypoglycemia • Hyperlipidemia • Hyperthyroidism
- 36. HCC: labs • Labs of liver cirrhosis AFP (Alfa feto protein) • Is an HCC tumor marker • Values more than 100ng/ml are highly suggestive of HCC • Elevation seen in more than 70% of pt
- 37. HCC: Diagnosis • Clinical presentation • Elevated AFP • US • Triphasic CT scan: very early arterial perfusion • MRI • Biopsy
- 38. US: HCC
- 39. CT: Venous Phase
- 41. Hepatocellular carcinoma, CT of the liver before (a) and 15 sec (b), 45 sec (c) and 90 sec (d), respectively, following intravenous contrast medium administration
- 42. HCC: Prognosis • Tumor size • Extrahepatic spread • Underlying liver disease • Pt performance status
- 43. HCC: Liver Transplantation • Best available treatment • Removes tumor and liver • Only if single tumor less than 5cm or less than 3 tumors less than 3 cm each • Recurrence rate is low • Not widely available
- 44. HCC: Resection • Feasible for small tumors with preserved liver function (no jaundice or portal HTN) • Recurrence rate is high
- 45. HCC: Local Ablation • For non resectable pt • For pt with advanced liver cirrhosis • Alcohol injection • Radiofrequency ablation • Temporary measure only
- 48. HCC: Chemoembolization • Inject chemotherapy selectively in hepatic artery • Then inject an embolic agent • Only in pt with early cirrhosis • No role for systemic chemotherapy
- 50. Fibro-Lamellar Carcinoma • Presents in young pt (5-35) • Not related to cirrhosis • AFP is normal • CT shows typical stellate scar with radial septa showing persistant enhancement
- 51. Hepatoblastoma • most common liver cancer in children • most commonly diagnosed during a child's first three years of life • usually present with an abdominal mass • Patients with familial adenomatous polyposis (FAP) are risk factor • Often elevated AFP • Treatment : Surgical resection, adjuvant CMT, and liver transplantation
- 52. Secondary Liver Metastases • The most common site for blood born metastases • Common primaries : colon, breast, lung, stomach, pancreases, and melanoma • Mild cholestatic picture (ALP, LDH) with preserved liver function • Dx imaging or FNA • Treatment depends on the primary cancer • In some cases resection or chemoembolization is possible
- 55. Pre contrast Arterial Phase Portal venous phase Delayed Hepatocelluar Ca Low attenuation Homogenous enhancement Washout of lesion Isodense Adenoma Low attenuation Homogenous enhancement 85% Iso or hypodense Iso or hypodense Haemangioma Low attenuation Peripheral puddles Partial Fill in Complete fill in FNH Iso/Low attenuation Homogenous enhancement Hypodense Isodense Metastasis(hypervascular) Low attenuation Homogenous enhancement Hypodense Metastasis Low attenuation Hypodense Hypodense Cyst Low attenuation No enhancement Abscess Low attenuation may have irregular margins Transient regional increase enhancement Ring enhancement Multiphasic CT of Liver
- 56. Summary • Hemangioma • Focal nodular hyperplasia • Adenoma • Liver cysts 1. Primary liver cancers • Hepatocellular carcinoma • Fibrolamellar carcinoma • Hepatoblastoma 2. Metastases Benign Malignant
Editor's Notes
- Only a minority of tumors contain calcifications, cystic components, fat or hemorrhage and will be detected on a NECT.
- Tumors enhance in arterial phase. Liver will enhance in the portal venous phase
- Will be visible as hyperdense lesions in a relatively hypodense liver
- also called the hepatic phase because there already must be enhancement of the hepatic veins
- HCC Cirrhotic liver with a single nodule in the right lobe showing marked arterial phase enhancement and early wash off in the portovenous phase are diagnostic features of a HCC.